David Simpson (Upper Bann) (DUP): The review has now been completed, the Prime Minister has, again, come to the Dispatch Box and apologised, and, yes, the murder has to be condemned. However, may I remind

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the Prime Minister that there are those of us on these Benches, including my own family, who have lost loved ones to the provos over the past 25 years? My family lost four of its members, but no review and no public inquiry was offered to them. When are we going to see equality for all families?

The Prime Minister: Many people in this House have suffered loss because of terrorists. I remember the first Member of Parliament who ever represented me, Airey Neave, and I think of Ian Gow, for whom I once had the huge privilege of writing a speech when I was a junior researcher. I remember going to have a drink with him in this House and getting to know him a little, and then reading one day that he had been murdered by the IRA. We cannot have an inquiry into every one of those murders; we have to find a way of trying to come to terms with the past. People have suffered dreadfully, but we have to find a way of moving ahead in Northern Ireland, which the people of Northern Ireland have done, and I believe it is our job to encourage that.

Valerie Vaz (Walsall South) (Lab): I thank the Prime Minister for coming to the House with this statement. Nevertheless, this remains a paper review. He has asked a number of his Departments to look at various issues and open up Whitehall to questions, so may I ask him to think again about a public inquiry? There is a Treasury Solicitor’s Department—a Government Department—which can co-ordinate a public inquiry very simply and cheaply, along the lines of the Baha Mousa inquiry. May I also ask the Prime Minister to meet the family today to ask them whether they think this paper review seeks the truth about the death of Pat Finucane?

The Prime Minister: I would not describe this simply as a “paper review”; Desmond de Silva did meet some people and conducted interviews. The hon. Lady should also remember that it was a review based on the fact that there had been the largest criminal investigation in British history, which had interviewed everybody and had the documentation. Alongside that—all the access to the Stevens material—Desmond de Silva also had access to all the intelligence and other material in Whitehall. On that basis, I think it is a very complete piece of work.

Ms Margaret Ritchie (South Down) (SDLP): I thank the Prime Minister for his statement. I stand solidly and squarely with Geraldine Finucane, her two sons and daughter, and the wider Finucane family. I recognise that many people and many families, not least Members of this House, from Northern Ireland have also suffered as a result of more than 30 years of the troubles. Does the Prime Minister not now consider, in view of de Silva’s report, which indicated very high levels of state collusion, that there is a need for an international public inquiry that will address issues of collusion and complicity? We in the Social Democratic and Labour party—our current three Members and our predecessors—always recognised and acknowledged the deep levels of collusion in Northern Ireland that resulted in murders right across the community, whether on the loyalist or on the republican side. For that reason, we now need an international public inquiry, to investigate not only Pat Finucane’s murder but all the other murders that were a result of state collusion and state complicity.

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The Prime Minister: This report is about state collusion and state complicity. I cannot think of a country anywhere else in the world that would have revealed in more detail, with no holds barred and no documents held back, the full extent of that collusion, and stood up, put its hand up and said, “This is what went wrong. This is what we apologise for. This is how we will make sure it never takes place again.” I recommend that the hon. Lady look at paragraph 113, where de Silva talks about his “Lessons for the future” and states:

“It is essential that the involvement of agents in serious criminal offences can always be reviewed and investigated and that allegations of collusion with terrorist groups are rigorously pursued. Perhaps the most obvious and significant lesson of all, however, is that it should not take over 23 years to properly examine, unravel and publish a full account of collusion in the murder of a solicitor that took place in the United Kingdom.”

I believe that Desmond de Silva is saying that that is what has been done; that is what has been laid bare. It has not taken a public inquiry; it has taken a Government to open up everything and say, “Let’s get the truth out. And here it is.”

John McDonnell (Hayes and Harlington) (Lab): If the Lawrence and Hillsborough families have taught us anything, it is that the families will not go away until they see justice in their terms. In an Adjournment debate I sought in 1999, I read into the record statements made in 1989 by an Under-Secretary at the Home Office. He had said that “a number of solicitors” were “unduly sympathetic” to the cause of the IRA, adding that these statements were made on the basis of “advice” and “guidance” from people “dealing with the matters”. Pat Finucane was murdered three and a half weeks later. The inquiry has said that there is no basis for any claim that the then Under-Secretary intended his comments to provide a form of political encouragement for any attack on any solicitor, but these words were certainly unwise and they contributed to a climate in which solicitors were made vulnerable—not only Pat Finucane, but Rosemary Nelson. Because these were statements by a Government Minister, does the Prime Minister’s apology extend to an apology for those expressions by the then Under-Secretary?

The Prime Minister: Let me first respond to the hon. Gentleman’s point about Hillsborough. There was a public inquiry and an inquest, but they were, in effect, faulty. It took an act by Government, with the Bishop of Liverpool, to lay open all the information. The families have thus been able to see the truth and, hopefully, they will be able to get that new inquest. I would argue that in this case that is what has happened: there was this full police investigation, but instead of having a public inquiry we have opened up and given all the information that is necessary.

On Douglas Hogg, I ask the hon. Gentleman to read the report carefully. It finds that Douglas Hogg was briefed in a way that he should not have been briefed, that that compromised him and that therefore what he said was unfortunate. But the report does not find that he in any way encouraged the action that took place or in any way knew about it. I would encourage the hon. Gentleman to read the report very carefully in that regard.

Mr Gregory Campbell (East Londonderry) (DUP): There has of course been widespread condemnation of the murder of Pat Finucane and of all the others in

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Northern Ireland. The Prime Minister alluded to trying to get at the truth of this issue. Does he accept that after a series of inquiries, reviews and reports that have cost tens of millions of pounds, if not hundreds of millions, into a small number of totally and utterly regrettable and unacceptable incidents, the problem that we have in this House is the credibility gap, because others out there caused the violence in the first instance and have never apologised, have never reviewed and have never reported? They have never said sorry for the activities that they carried out, which ensured that others responded to their activities. Will the Prime Minister indicate that they should open up and say sorry for what they have done—for 30 years of murder?

The Prime Minister: Everyone has to face up to what they did and what they got wrong. It is up to those people responsible for violence, for terror, for murder to do that; they should apologise for what they did. But let me repeat: we should not put ourselves in this House, in government and in a state that believes in the rule of law, democracy and human rights, on a level with those organisations. We expect higher standards and when we get it wrong, we need to explain and completely open up in the way that we have done today.

Jim Shannon (Strangford) (DUP): I thank the Prime Minister for his statement, and I agree with his decision not to have a public inquiry. The Prime Minister is aware of the hurt that runs very deep among the whole of Northern Ireland—among people on both sides. Hurt is not just on one side of the community; it is universal and we all have it. I am thinking of the Darkley gospel hall massacre, when people worshipping God on a Sunday night were killed by republicans; the people killed—burnt to a cinder—and injured by republicans at the La Mon restaurant; the people who were killed and injured by republicans at the Abercorn restaurant as they were enjoying a meal; the Ballydugan killing by republicans of four Ulster Defence Regiment men, three of whom I knew personally. Some £191 million has been set aside for the Bloody Sunday inquiry into the deaths of 13 people. The Prime Minister has mentioned the Historical Enquiries Team, whose budget is £38 million to carry out 3,487 inquiries into murders. What steps has he taken to help the HET do more and get answers for people who have lost loved ones?

The Prime Minister: We continue to fund the Historical Enquiries team. I think it does good work and it should continue to do that. I take the hon. Gentleman’s point that whatever terrible event we are discussing, people will always bring up other terrible events and quite rightly say, “Well, what about an inquiry into that? What information can we find out about it?” What is different in this case is that it highlights the appalling level of collusion there was and brings to the surface, effectively, not just one appalling murder but a series of appalling steps that were being taken and that need to be addressed.

Ian Paisley (North Antrim) (DUP): As we kick over the charred embers of Ulster’s past, an appalling and awful picture emerges, but today we are seeing only one tiny part of that. The Prime Minister is utterly correct to make it clear that there should not be a public

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inquiry into this matter, first because it would wasteful, and secondly because if he grants a public inquiry in this case he knows that a chorus of hundreds of people from before Patrick Finucane was murdered and hundreds of people from after Patrick Finucane was murdered will ask, “Why not my relative? Why not me?” The Prime Minister is right to hold fast to that view and should not be swayed.

I also agree with the points made by the hon. Member for Vauxhall (Kate Hoey) and my hon. Friend the Member for South Antrim (Dr McCrea) and ask the Prime Minister to respond to them directly. They made it clear that there is more than a shred of evidence that the Republic of Ireland’s Government armed the Provisional IRA and that there should be an investigation into that and honesty about it so that we can see the whole picture.

My constituents are sick and tired of a one-sided narrative of revisionism that says that the Provisional IRA were actually quite good and the troops and police were quite bad. That, in the current circumstances in Northern Ireland, is bloody stupid—and I mean literally bloody. It will send a signal to my constituents that people have to push, kick, throw and petrol bomb to get what they want, and not abide by the law. We are trying to tell them all to abide by the law.

The Prime Minister: I thank the hon. Gentleman for what he said about my decision not to hold a further public inquiry. Let me be clear again that that is not because the Government want somehow to hide or run away from the truth. We could not have marched further, faster or more clearly towards the truth than we have by publishing this document today. As for his point about republican terrorism, let me read to him from paragraph 117 of the report’s executive summary, where de Silva states:

“I have no doubt, however, that PIRA was the single greatest source of violence during this period and that a holistic account of events of the late 1980s in Northern Ireland would reveal the full calculating brutality of that terrorist group.”

That is the point that he makes and he is right to make it.

Mr Speaker: I thank the Prime Minister and colleagues.

Bills Presented

Multinational Motor Manufacturing Companies (Duty of Care to Former Employees) Bill

Presentation and First Reading (Standing Order No. 57 )

Geraint Davies, supported by Stephen Metcalfe, Mrs Siân C. James, Martin Caton and Mike Freer, presented a Bill to require multinational motor manufacturing companies to provide a duty of care to former employees in respect of pension provision.

Bill read the First time; to be read a Second time on Friday 1 February 2013, and to be printed (Bill 107).

Lords Spiritual Bill

Presentation and First Reading (Standing Order No. 57 )

Mr Frank Field presented a Bill to make provision for filling vacancies among Lords Spiritual sitting and voting as Lords of Parliament.

Bill read the First time; to be read a Second time on Friday 18 January 2013, and to be printed (Bill 108).

12 Dec 2012 : Column 319

Planning Act 2008 (Amendment)

Motion for leave to bring in a Bill (Standing Order No. 23)

1.53 pm

Phil Wilson (Sedgefield) (Lab): I beg to move,

That leave be given to bring in a Bill to amend the Planning Act 2008 to exempt planning applications for onshore wind farms producing 50 megawatts or more; to provide that they be referred for decision to local planning authorities; and for connected purposes.

I am pleased to report that County Durham has played more than its part in the development of renewable energy. The equivalent of 70% of the county’s household electricity comes from renewable sources; what is more, the equivalent of 27% of the county’s energy needs are already supplied from renewable sources, only 3% off the 2020 target of 30%. Some 68% of the renewable energy generated comes from wind energy. In total, 193 MW of renewable energy is either operational or approved, 132 MW from wind. A further 109 MW is in planning, all of it from wind energy. That is one of the best records of any local authority area in England.

I want to see further renewable energy development in the county, but as far as wind farm development is concerned, I believe the landscape in the county is near or at full capacity. If it is allowed to continue, the cumulative impact on the landscape will become severe. The county now hosts 17 operational wind farms, a further six have been permitted but are not yet operational, and another 13 are in planning. At present, County Durham has 70 commercial-scale turbines and a total of 155 turbines of various sizes. Another 72 turbines of all sizes are in planning, without counting the 24 turbines E.ON would like to build at the Isles in my constituency, which, on a good day, would generate 63.5 MW of electricity.

It is apparent that my Bill is not born out of any sense of nimbyism, because Durham has done its bit. The county understands the need for a good energy mix and has played its part. Today in Durham, the sheer size of the turbines is starting to place a burden on the landscape that I do not believe was envisaged by the legislators when the policy was devised to ensure that local people, through their planning authority, could not say no to a wind farm proposal if the energy generated exceeded 50 MW. Instead, the decision lies with the Secretary of State, through the Planning Inspectorate.

The Isles wind farm proposed for my constituency exceeds the 50 MW threshold and must therefore be referred to the Planning Inspectorate because it is deemed a nationally significant infrastructure project. The county council will merely be consulted. The national significance of the Isles wind farm is not its physical size but the energy it produces. According to E.ON, on a good day it would produce sufficient energy for towns such as Newton Aycliffe and Sedgefield in my constituency. Newton Aycliffe and Sedgefield are great places to live, but is a wind farm that can generate sufficient energy for them an infrastructure project that warrants national significance? I think not. For me, Hartlepool nuclear power station, which is about 10 or 12 miles from Sedgefield and generates 1,190 MW of electricity, is an infrastructure project of national significance.

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This is why I believe that onshore wind farms, especially in areas where there are many of them, should be exempt from the 50 MW threshold and that the planning decision on whether they should be built should lie with the local planning authority. If the Isles wind farm gets the go-ahead, local people will be left with a wind farm that covers 12.5 square miles and hosts 24 wind turbines, seven of which will be 126.5 metres high, whereas the other 17 will be 100 metres high. That is in an area that is designated as able to accommodate only four turbines. It would be the largest array of turbines as part of a network of wind farms on the Tees valley plain, including those already operational at Butterwick and the Walkway, as well as those which have received consent at Moor House farm, Lambs Hill and Red Gap farm but have yet to be built.

The Isles wind farm is not a power generating station of national significance, but it is an imposition on local people. Their views should be listened to and the decision on any approval for such a wind farm should be made locally. But where exactly did the 50 MW threshold come from? The figure is enshrined in the Planning Act 2008, in a spirit of consistency since the same figure was used in the Electricity Act 1989. That Act is now almost a quarter of a century old and wind farm technology has moved on.

In fact, during the debates on the 1989 Act, wind farms did not take centre stage. The Government wanted to create a new tranche of renewable energy capacity, but hydro was mentioned rather than wind. In 1994, when Durham county council wrote “Renewable energy in County Durham”, the first strategy document of its kind to be prepared by a local authority, the average wind turbine generated 300 to 400 kW and had a tip height of 40 to 50 metres. By 2001, the wind farm at Tow Law in County Durham was furnished with the latest turbines, which generated 750 kW and stood 71 metres high. The technology has moved on apace, but so has the size of the turbines, from 40 to 50 metres at the end of the 1990s to well over 100 metres today. Some of the turbines destined for the Isles will be 126.5 metres high—six times the height of the Angel of the North or almost twice the height of Durham cathedral. Consequently, the Government should look at increasing the 50 MW threshold.

The threshold is used by utility companies to their advantage because they can design a wind farm to exceed the 50 MW threshold, taking the planning decision out of the hands of local planning authorities. E.ON’s proposal for the Isles is a case in point. Its original proposal was for 10 turbines, but it was withdrawn because it knew that in all likelihood Durham County Council would turn down the application because it was following an Arup report on wind farm landscape impact, which said that the Isles could not take more than four turbines. E.ON withdrew the application, and introduced a new proposal for 45 wind turbines, but has settled on a wind farm of 24 turbines after taking planning restraints into consideration.

To achieve that, however, E.ON has performed all kinds of contortions. The area allocated for the wind farm is huge, but to avoid conservation areas it is designed to stand in two clusters about 2 km apart, each with its own substation. Looking at the map, people would think there were two distinct wind farms, not one. I have pointed that out to E.ON, which told me

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that as the wind turbines appear within the area designated for the wind farm, it is one wind farm. On that basis, E.ON should draw a red line around the whole of County Durham and have done. E.ON’s approach is cynical and takes for granted the good nature of the people of County Durham.

Durham has led the way in the pursuit of a cleaner and sustainable environment, and Durham county council is to be congratulated. I am not against wind farms, and accept the need for a strong energy mix. Durham county council and the county have done their bit, and we are proud of it. The possibility of a huge wind farm in an area that has proved that it is not averse to accepting wind farms is a step too far, which is why the threshold figure of 50 MW should be withdrawn for onshore wind farms, or at least increased significantly, as they do not provide infrastructure of national importance when compared with nuclear power stations, for example.

County Durham’s industrial heritage is one of coal mining. Those days have gone, and the slag heaps that once scarred the landscape have been removed. Yes, a wind turbine is more elegant than the pit heaps I grew up with, but with the pit heaps came thousands of jobs. What we are experiencing in County Durham today is the re-industrialisation of the landscape without the jobs. What we face in County Durham is massive utility companies being cynical in their approach by attempting to impose on the landscape wind farms which are not really of national importance.

Exempting wind farms from the 50 MW planning threshold, especially in locations where wind farms already dominate and are close to communities, will ensure that other parts of the country, which need to play their part in developing renewable energy, including wind power, are not taken for granted.

Question put and agreed to.

Ordered,

That Phil Wilson, Pat Glass, Tom Blenkinsop, Grahame M. Morris, Natascha Engel, Angela Smith, Ian Lavery, Mrs Mary Glindon and Mr Richard Bacon present the Bill.

Phil Wilson accordingly presented the Bill.

Bill read the First time; to be read a Second time on Friday 1 March 2013, and to be printed (Bill 109).

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Opposition Day

[12th Allotted Day]

NHS Funding

2.4 pm

Andy Burnham (Leigh) (Lab): I beg to move,

That this House notes with concern the letter of 4 December 2012 from the Chair of the UK Statistics Authority, Andrew Dilnot CBE, to the Secretary of State for Health concerning public expenditure on health, further notes Mr Dilnot’s statement that expenditure on the NHS in real terms was lower in 2011-12 than it was in 2009-10; and calls on Ministers to reflect this position in their public statements.

Some people question whether Opposition days ever achieve anything, but not us. Last month, we brought to the House our concern about plans for regional pay in the national health service, which found an echo among Government Members. Within days, the plans of the previous Health Secretary for market-facing pay in the NHS were scuppered in the autumn statement. To some, that was just another day, another U-turn, in the life of this shambolic coalition—no big deal—but to thousands of NHS staff in the south-west facing pay cuts it was a real relief, although we are still waiting for the consortium formally to back down. We will be vigilant until it does so.

Fresh from that success, we set ourselves a more challenging task in today’s Opposition day debate to bring some much-needed honesty to the public debate on the NHS, particularly on NHS spending. Across the country, people can see the signs of an NHS in increasing distress: cataract operations are restricted; A and E departments and walk-in centres have been closed; hospitals are full to bursting, some struggling for survival; over 7,000 nursing jobs have been lost—[ Interruption. ] Government Members should listen to the facts before they shout out, because this is the reality and the chaos that the previous Secretary of State created on the ground. People can see that with their own eyes, but when they go home and switch on the television they see Ministers standing at the Dispatch Box making complacent boasts about “real-terms increases” that they have given the NHS and saying that everything is fine.

John Glen (Salisbury) (Con): If the right hon. Gentleman wants to have integrity and demonstrate honesty in this debate, will he at the outset condemn the Labour party in Wales for the real cuts that everyone knows are being made in the Welsh health service? Will he level with the British people about that, rather than offer this empty political rhetoric that does not deal honestly with what is happening in Wales?

Andy Burnham: We are discussing the hon. Gentleman’s Government today, but let me deal with Wales. His Government have given the Welsh Assembly Government a real-terms £2.1 billion cut. The Welsh Assembly Government have done their best to protect health spending in that context: they have protected the NHS budget in cash terms. May I also point out to the hon. Gentleman that since 2010 there has been no real reduction in front-line staff, particularly nurses, in Wales, which is quite unlike the position under his Government? Before he appears a bit too cocky on these matters he should

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read up on the facts. The Welsh Assembly is doing the best that it can with the awful hand of cards that he and his Government dealt it.

There is a mismatch between ministerial rhetoric and the reality on the ground in the NHS, and it is in danger of causing confusion. If left unchallenged, it may lead to unfair claims that the problems in the NHS are all down to its staff and have nothing to do with the Government. Today we need a bit of accountability and a bit of honesty. Once and for all, we will nail the myths, spin and sheer misrepresentation of the facts that roll off the Government Benches week after week.

Julian Smith (Skipton and Ripon) (Con): In North Yorkshire, we have some of the lowest spending per capita in Britain. Does the right hon. Gentleman regret the removal and reduction of health spending on old people and rural areas under his watch?

Andy Burnham: I think that the hon. Gentleman should withdraw that remark, because there was no reduction in health spending on my watch. I left plans for an increase, as I am about to explain. He illustrates the point that I am making: we are getting half-truths, spin and misrepresentation from Government Members on NHS spending. Indeed, we just got some more, and it is about time that we had a bit more accuracy in the House from them.

The story starts with the 2010 Conservative party manifesto. Let me quote from it:

“We will increase spending on health in real terms every year”.

The Parliamentary Under-Secretary of State for Health (Anna Soubry): Absolutely right.

Andy Burnham: Mr Dilnot may be watching; the Minister needs to be careful in what she says.

That promise was carried into the coalition agreement, which said:

“We will guarantee”—

guarantee, mind—

“that health spending increases in real terms in each year of the Parliament”.

The Secretary of State has stopped nodding; he was nodding earlier. [Interruption.] I will be interested to hear how the Conservatives make those claims stack up, because week after week, Ministers from the Prime Minister downwards have stood at the Dispatch Box and claimed that that is exactly what they have delivered.

Until recently, this appeared prominently on the Conservative party website:

“We have increased the NHS budget in real terms in each of the last two years”.

Then, on 23 October, the Secretary of State said to the House:

“Real-terms spending on the NHS has increased across the country”—[Official Report, 23 October 2012; Vol. 551, c. 815.]

[Interruption.] “It has”, he says again today. Okay, but this is where the story changes, because last week, he received a letter from the chair of the UK Statistics Authority, Andrew Dilnot CBE. Let me quote the key sentence, which puts Mr Dilnot and the Secretary of State at odds, if I heard the Secretary of State correctly a moment ago:

“On the basis of these figures, we would conclude that expenditure on the NHS in real terms was lower in 2011-12 than it was in 2009-10.”

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[Interruption.] I am coming on to it all. In other words, NHS spending is lower, in real terms, after the first two years of the coalition, than when Labour left office.

Mr Stephen Dorrell (Charnwood) (Con): Can the right hon. Gentleman confirm that the next sentence says:

“Given the small size of the changes and the uncertainties associated with them, it might also be fair to say that real terms expenditure had changed little over this period”?

Andy Burnham: Let me say to the Chair of the Health Committee that today I am challenging the veracity of ministerial statements made at the Dispatch Box. I am sure that as a former Secretary of State with many years’ experience of the House, he will know that when Ministers are at the Dispatch Box, they have to be accurate; they have to say the truth. A moment ago, the Secretary of State for Health said that he and the Conservative party were right to say that NHS spending had increased in real terms. That directly contradicts the letter that the Secretary of State had just been sent. Is it any wonder that the public are losing trust in the Government if that is the kind of arrogant spin that comes from those on the Government Benches, week after week?

Mr Dorrell rose

Andy Burnham: I give way to the right hon. Gentleman once more, but then I will make some progress.

Mr Dorrell: Is it fair to characterise the letter as saying that

“real terms expenditure had changed little over this period”?

Andy Burnham: That is what the letter says, but it is a cut; that is what the letter says. The right hon. Gentleman might say that, in the context of the NHS budget, £1.9 billion is not very much, but it is still a change, and it is a cut. He stood for election on a manifesto promising a real-terms increase. He has just acknowledged that there has been a real-terms cut. Does he acknowledge that there has been a real-terms cut? I think he will have to. I am amazed; the Conservatives come here today to try to con the public, yet again, into thinking that they are fulfilling their promise.

Robert Flello (Stoke-on-Trent South) (Lab): I enjoy every moment in which a blow is landed on the Government; they squirm and try to come back. Will my right hon. Friend comment on how much of the budget is being thrown away and wasted on top-down reorganisation, redundancy payments and everything else that is going on?

Mr Deputy Speaker (Mr Lindsay Hoyle): We need short interventions. There are a lot of Members who wish to speak. I am a little bothered by the comments made; I am sure that the right hon. Member for Leigh (Andy Burnham) did not want to suggest that the Prime Minister conned people.

Andy Burnham: I am coming to the point made by my hon. Friend the Member for Stoke-on-Trent South (Robert Flello), because the context is that £1.6 billion, on the Government’s own figures, was spent on the back office, and taken away from the front line. The Chair of the Select Committee says that the cut was a

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little one, as though that is okay—“It’s really an increase, because it’s only a little cut”—but one has to add £1.6 billion to that to see the full extent of the diversion of funds from the NHS front line.

As the chair of the UK Statistics Authority has established, NHS spending was lower in the first two years of this coalition than when Labour left office. [Interruption.] The Secretary of State says that it is the same. Let us have some honesty here. Mr Dilnot says that it was a cut; accept what he says, and get on with the job. If the Secretary of State starts being a bit more honest at the Dispatch Box, he might get a bit more respect from the public.

The Prime Minister has cut the NHS—fact; but just as he airbrushed his poster, he has tried to airbrush the statistics, and he has been found out. To be fair, the Conservatives admitted it and corrected the Tory party website, but the problem is that we have a long list of similarly false claims made in the House that, as of now, stand uncorrected. Today, we invite the Secretary of State to correct the parliamentary record in person.

I am not surprised to see a few sheepish looks on the Conservative Benches, because we have been checking Conservative Members’ websites, and we found that the hon. Members for South West Bedfordshire (Andrew Selous), for North Herefordshire (Bill Wiggin), and for Hendon (Dr Offord), the hon. and learned Member for Sleaford and North Hykeham (Stephen Phillips), and the hon. Member for Mid Derbyshire (Pauline Latham)—

Anna Soubry: They are sheep, are they?

Andy Burnham: They are certainly sheepish today; they need to get back to their offices pretty sharpish to amend their websites in light of the letter from the chair of the UK Statistics Authority.

Barbara Keeley (Worsley and Eccles South) (Lab): The website of the Conservatives in Salford says, on the budget that was going to increase,

“we would see more investment in our local NHS”

under a Conservative Government, but in Salford Royal hospital, 750 jobs have been cut. Between them, all our local hospitals have had 3,100 jobs cut in the past couple of years, and two walk-in centres have closed. If the budget is the same, why all these cuts?

Andy Burnham: This is the reality on the ground, as my hon. Friend says. There is also the mental health budget cut. There has been a mismatch; people see all those things, yet they hear the statements from the Government, and it does not make any sense, but now the truth and the facts about our NHS are being told, and things will begin to make sense to people.

What I find most troubling about all this, and most revealing about the Government’s style and the way that they work, is that even when they are warned by an official watchdog, they just carry on—as they are doing today—as if nothing had happened. When they admitted cutting the NHS in 2011-12 by amending their website, what was the excuse that they offered to Sir Andrew? Labour left plans for a cut; that is what the Prime Minister said at the Dispatch Box last week. It is what the Secretary of State said in a letter replying to Mr Dilnot. Again, that is simply untrue.

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According to Treasury statistics, Labour left plans for a 0.7% real-terms increase in the NHS in 2011-12. From then on, we had a spending settlement giving real-terms protection to the NHS budget. It was this Government who slowed spending in 2010-11, who allowed the resulting £1.9 billion underspend to be swiped back by the Treasury, contrary to the Secretary of State’s promise that all savings would be reinvested, and who still have published plans, issued by Her Majesty’s Treasury, for a further 0.3% cut to the NHS in 2013-14 and 2014-15, contrary to the new statement that the Conservatives have just put on their website. The Secretary of State has a lot of explaining to do.

Andrew Selous (South West Bedfordshire) (Con): I should be interested in the right hon. Gentleman’s comments on the statement by John Appleby, the chief economist of the King’s Fund, who said that before the general election, the former Chancellor left plans for 2011-12 and 2012-13 that would see a cut in real terms. What does the right hon. Gentleman say to that?


Andy Burnham: I have not seen the quote, but I did the deal with the former Chancellor of the Exchequer just months before the general election, protecting the NHS in real terms. A deal was done for schools and for the Home Office too. Those were the plans. At the election I was arguing for real-terms protection. The Secretary of State was on the hustings calling for real-terms increases. I said it would be irresponsible, yes, to give real-terms increases over and above real-terms protection because the only way he could pay for that would be taking it off councils, hollowing out the social care budget. That is what I said at the election, but the right hon. Gentleman has not even given real-terms protection. He has cut the NHS in real terms, so it beggars belief that he has the nerve to heckle and shout out from the Front Bench, when he has cut the NHS lower than the plans that I had left in place.

Clive Efford (Eltham) (Lab): It is not just on the budget that the Government have let people down. They promised that they would not close accident and emergency departments. Before the general election the former Secretary of State went to Bexley and said he would not close the accident and emergency department at Queen Mary’s, Sidcup, and it closed after the general election. Now they are planning to close the A and E at Lewisham—another broken promise about the NHS. It just goes to show: you can never trust the Tories with the NHS.

Andy Burnham: The two guilty men here have a list of broken promises as long as their arm. The previous Secretary of State toured marginal seats before the election, promising the earth—“Burnley A and E? Oh, we’ll re-open that. Whatever you want. Chase Farm? That won’t close.” It was unbelievable cynical politics. It was all self-serving politics for their own ends and it had nothing to do with the reality in the NHS, but the problem for the present Secretary of State is that he has presented this false version of events to the House. On 13 November he said that

“there has been a real-terms growth in spending—actual money spent in the NHS, compared with Labour’s plans.”—[Official Report, 13 November 2012; Vol. 553, c. 188.]

[Interruption.] He says there has been. I ask for your help, Mr Deputy Speaker. How can Ministers deny the facts—deny what the watchdog is telling them? What do

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we do in such circumstances, when they have the sheer nerve and brass neck to carry on making these false statements?

Based on what we know, there is no way the Secretary of State can back up that claim, and I ask him to withdraw it today. It is an inaccurate claim. He made it at the Dispatch Box; the onus is on him to withdraw it. We know that he is taking time to come to terms with his brief, but he is in danger of developing a credibility problem with his utterances in the House. Take this from last month’s Health questions:

“Cancer networks are here to stay and their budget has been protected.”—[Official Report, 27 November 2012; Vol. 554, c. 127.]

But again the truth emerges, and it is somewhat different from the version of events presented to us by the Secretary of State. On Monday, responding to excellent research by my hon. Friend the Member for Leicester West (Liz Kendall), the national cancer director conceded that in future cancer networks would have to live with a smaller budget. What are we to do? Who are we to believe? We have a Secretary of State who is making statements that contradict his national cancer director. It is shameless.

Lucy Powell (Manchester Central) (Lab/Co-op): Even the north-west regional centre for cancer treatment, the Christie hospital, recently announced that 213 posts will go. I do not know how it stacks up with the Secretary of State’s claim that the NHS budget is going up, when we see cancer patients getting a reduced service at the Christie hospital.

Andy Burnham: The priorities are all wrong. The Government are spending the money on a reorganisation that none of us wanted in the north-west, and as my hon. Friend says, cancer networks are being cut and are shedding staff. As my hon. Friend the Member for Leicester West revealed this week, they are cutting back on the vital work that they do—and there could be no more vital work. Yet we continue to have a false version of events given to us. Ministers must think we are daft, but we are telling the facts to the country today and people will judge for themselves.

When we put the whole picture together, what we see is a tissue of obfuscation and misrepresentation of the real position on NHS spending. The hon. Member for Mid Bedfordshire (Nadine Dorries), who is, sadly, not in the House today, once made some interesting observations about those on the Government Front Bench, but it is not just that they

“don’t know the price of pint of milk”.

The arrogance of which she spoke seems to give them a feeling that they can claim that black is white and expect everyone to believe it. If they say it is so, then it must be so. Well no, actually. The intelligence of the House need not be—

Chris Skidmore (Kingswood) (Con): On a point of order, Mr Deputy Speaker. Has the right hon. Member for Leigh (Andy Burnham) informed the hon. Member for Mid Bedfordshire (Nadine Dorries) that he would be making comments about her in the debate today?

Mr Deputy Speaker (Mr Lindsay Hoyle): That is not a point of order.

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Andy Burnham: Yes, I have done so, Mr Deputy Speaker.

If in future any Minister mentions the NHS and real-terms increases in the same sentence at the Dispatch Box, Members on all sides will at least have the facts. Better still, by carrying our simple motion this evening, we can give the House the opportunity to make sure that Ministers take much more care than they have previously shown with their statements on NHS spending.

Let us look to the future. What does all this mean for the NHS and what effect is the Government’s cut to its budget having in the real world? In its briefing for today’s debate, the NHS Confederation refers to a survey of NHS leaders which found that a full 74% described the current financial position as “the worst they had ever experienced” or “very serious”. The reason why the Government’s cuts feel much deeper to people working in the NHS, as we heard a moment ago, is that they are contending with the added effect of a reorganisation that nobody wanted and that they pleaded with the former Secretary of State to stop.

Cuts and reorganisation are a toxic mix. According to the Government’s own figures, a full £1.6 billion has been diverted away from patient care and the NHS front line and spent on back-office restructuring. Look at the waste already: a full £1 billion spent on managerial redundancies—1,300 six-figure pay-outs and, scandalously, 173 pay-outs over £200,000. [Interruption.] The Secretary of State chunters away. I am surprised he has the nerve even to be here. Such pay-outs are unforgivable and unjustifiable when patients are seeing treatment restricted and nurses laid off in their thousands. But it is not just the financial cost. It is the opportunity cost—the colossal distraction this has proved to be from having the focus where it should be—on the money.

After the election, the £20 billion Nicholson challenge should have been the only show in town. Instead, no one stood up in Cabinet to the previous Secretary of State, who was allowed to proceed with his vanity reorganisation of the NHS. The consequence has been two years of drift, where no one knows who is making the decisions. The danger of this unwieldy and unmanaged approach to the efficiency drive is that, as trusts start to panic about the future, increasingly drastic cuts are being offered up that could have serious consequences for patient care.

I want to end by focusing on four such consequences. First, let us look at staffing levels on the NHS front-line. For two years, we have had the mismatch of Ministers making boasts about rising spending while the number of staff was dropping at an alarming rate. A full 7,134 nursing posts have been lost since the coalition came in, with 943 in the past month alone. [Interruption.] Government Members keep mentioning doctors. We left those plans for doctors coming through. The Secretary of State has not done anything about the training of those doctors, but on his watch he has seen more than 7,000 nursing posts cut.

Training places are being been cut by 4.6% this year, after a 9.4% cut in 2011-12. No wonder the chief executive of the Royal College of Nursing warns that we are “sleepwalking” into a crisis. Peter Carter says:

“On a daily basis, nurses are telling us they do not have enough staff to deliver good quality care.”

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The situation has taken a serious turn. In its annual report, the Care Quality Commission found that 16% of hospitals in England did not have adequate staffing levels. I am surprised that a warning of this seriousness has not received more attention. It cannot go ignored. It would seem that the NHS is failing to learn the lessons of the failure at Mid Staffordshire, where the first Francis inquiry found inadequate staffing levels to be one of the main reasons why care standards fell so low.

The Health Secretary tells the Health Service Journal today that he is not going to interfere with the day-to-day running of hospitals, but let me remind him that it is his responsibility to ensure that our hospitals are safe. He must develop an urgent plan to stop the job losses and protect the NHS front line. He should tell us which hospitals do not have enough staff and explain what action he is taking on the CQC’s warning to ensure that all hospitals in England have safe staffing levels.

The second consequence of Government cuts to the NHS is the growing number of restrictions on treatment. We have revealed how 125 separate treatments have been restricted or stopped altogether since 2010, including cataracts, knee replacement and varicose veins. Just as they make false boasts about increasing NHS spending, so we hear repeated claims about reducing waiting lists. But that is because people cannot get on the waiting list in the first place.

Figures from the House of Commons Library show the effect of those restrictions on patients. More than 50,000 patients are being denied treatment and kept off NHS waiting lists, and there have been big falls in operations for cataracts, varicose veins and carpal tunnel syndrome. Ministers have promised to stop cost-based rationing if they are given evidence of it, but we have presented them with the evidence on a number of occasions, so let us now see some action.

Thirdly, the lethal mix of cuts and reorganisation is destabilising our hospitals. They are the first to feel the full effects of the free-market ideology that the Government have unleashed on the NHS. There is no longer one NHS approach in which spending is managed across the system; there is a broken-down, market-based NHS. The Government’s message to England’s hospitals is this: “You’re on your own. There’ll be no bail-outs. Sink or swim. But if it helps, you can devote half your beds to treating private patients.” We see the signs of increasing panic as hospitals struggle to survive in this harsh new world. In Bolton, South Tees, and Maidstone and Tunbridge Wells, a large number of staff have been given 90-day redundancy notices, and we see half-baked plans coming forward to reconfigure services with efforts to short-circuit public consultation.

Will the Secretary of State today remove the immediate threat to Lewisham A and E by stating clearly that it is a straightforward breach of the administration process rules to solve the problems in one trust through the back-door reconfiguration of another? Will he ensure that the future of all A and E provision in Greater Manchester is considered in the round as part of a city-wide review, rather than allowing the A and E at Trafford to be picked off in advance. In St Helens and Knowsley Hospitals NHS Trust, will he reverse the comments of the previous Secretary of State, who told

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the clinical commissioning groups that they had no obligation to honour financial commitments to the hospitals entered into by the previous primary care trusts? It is chaos out there. The Secretary of State urgently needs—

[

Interruption.

]

In fact, all the Health Ministers urgently need to get a grip, not just the Secretary of State.

Robert Flello: Is my right hon. Friend aware that the West Midlands ambulance service only yesterday advised that there are about half a dozen hospitals in the west midlands whose A and E staffing situation is so critical that it is having a knock-on effect on their ambulance turnaround times?

Andy Burnham: I hear reports from ambulance services all over the country that they simply cannot hand over patients at the door of A and E departments and are having to queue outside. Consequently, large swathes of the country are being left without adequate ambulance cover. That is unacceptable, especially as we go into winter and temperatures drop. We need to see some evidence that the Government have a grip on these things. I have been told that large parts of my constituency have occasionally been left without adequate ambulance cover. We must have answers on these matters today.

Dr Sarah Wollaston (Totnes) (Con): I am very disappointed to hear the right hon. Gentleman talk down the NHS. As he has just acknowledged, before the election the NHS knew that it was facing an unprecedented efficiency challenge. He will also know that under Labour productivity in the NHS fell continuously. I wonder whether—[ Interruption. ] Okay, but for almost every year—

Mr Deputy Speaker (Mr Lindsay Hoyle): Order. The hon. Lady needs to ask a sharp and punchy question as an intervention, and very quickly.

Dr Wollaston: Will the right hon. Gentleman acknowledge the NHS’s achievement in making a productivity gain?

Andy Burnham: The hon. Lady just made another untrue statement. She talks about talking down the NHS, but productivity has not fallen. I am sorry, but let us have some honesty. We are not just going to sit here and take one statement after another—

Mr Deputy Speaker (Mr Lindsay Hoyle): We all know that all Members are very honest in this House.

Andy Burnham: Inadvertent claims are being thrown around the House all the time.

Fourthly, and finally, cuts and reorganisation are resulting in a crude drive to privatise services, prioritising cost over clinical quality. Across England, deals have been signed to open up 396 community services to open tender under any qualified provider, but those deals are not subject to proper public scrutiny because they are held back under commercial confidentiality. In Greater Manchester, plans are advanced to hand over patient transport services to Arriva, despite the fact that an in-house bid scored higher on quality and despite the fact that the CQC recently found serious shortcomings with the same provider in Leicestershire. The trouble is

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that nobody has asked the people of greater Manchester, or more importantly the patients who rely on that service, whether they want that change.

Lucy Powell: My right hon. Friend might not be aware of another point. The patients who use the Greater Manchester passenger transport service are coming to me regularly and crying their eyes out in distress at this decision—[ Interruption. ] The hon. Member for Beverley and Holderness (Mr Stuart) says “Aaah”, but those are poor and vulnerable people who rely on that service to take them to and from hospital. It is an absolute disgrace that the contract has been given to Arriva bus service, so don’t patronise them or me. I thank my right hon. Friend for giving way.

Andy Burnham: Thank God my hon. Friend got up to deliver that to Government Members, because they need to hear a bit more of it. They say “Aaah,” but we are talking about people who desperately need that service, trust it and like it the way it is. The Government have not even bothered to consult them about the changes they are making. That is what is so wrong.

“Any qualified provider” is turning into the NHS version of compulsory competitive tendering, a race to the bottom and a rush to go for the cheapest bid, regardless of the effect on patients and services. What clearer symbol could there be of a privatised, cut-price coalition NHS than the decision to award patient transport in Greater Manchester to a bus company?

Let me remind the Secretary of State of the rights of patients and staff as set out in the NHS constitution:

“You have the right to be involved, directly or through representatives, in the planning of healthcare services, the development and consideration of proposals for changes in the way those services are provided, and in decisions to be made affecting the operation of those services.”

If the people whom my hon. Friend the Member for Manchester Central (Lucy Powell) referred to sought to enforce those rights by bringing a legal action against the North West ambulance service, can the Secretary of State confirm that there would be a fair chance that it would have to halt its plans? If so, why does he not just press that pause button and ask people whether they want their ambulance services run by a bus company?

The first line of the NHS constitution states:

“The NHS belongs to the people.”

But it will not when this Government have finished with it. We are losing the NHS, and that is why we will keep stepping up the fight for it. People will remember the personal promises the Prime Minister made on the NHS in order to win office, promises that it now seems had more to do with his desire to detoxify the Tory brand than with any genuine regard for the NHS. He promised no top-down reorganisation of the NHS; that was broken. He promised a moratorium on hospital changes; that was broken. He promised real-terms increases in every year of this Parliament; that was broken. They can now see the chaos that the breaking of those promises is visiting on the NHS: nurse numbers cut, health visitors cut, mental health cut, cancer networks cut, and cataract operations cut. He is the man who cut the NHS, not the deficit. The House cannot vote tonight to stop the damage, but it can put down a marker against an arrogant and incompetent Government who need to show the NHS, its patients and staff a little more respect. I commend the motion to the House.

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2.37 pm

The Secretary of State for Health (Mr Jeremy Hunt): We have heard a lot of bluster and nonsense today. At its heart is an extremely uncomfortable truth for the Opposition: this Government are spending more on the NHS than Labour would have spent. That spend has moved away from consultancy and the back office to the front line, so the NHS is now performing better—I know that it is uncomfortable, but it is true—than it ever did under Labour. That means more treatment—[ Interruption. ]This might not be what Opposition Members want to hear, but they might as well listen. That means more treatment, more care and more lives saved. The previous Government talked the talk on the NHS, but it is this Government who have delivered an NHS of which we can be immensely proud.

Grahame M. Morris (Easington) (Lab): Will the Secretary of State give way?

Mr Hunt: I will make a little progress before giving way.

Lyn Brown (West Ham) (Lab) rose

Mr Hunt: I said that I would make a little progress, if that is all right.

I must confess to being both surprised and delighted at this afternoon’s motion, because I would have thought that the last thing the right hon. Member for Leigh (Andy Burnham) would have wanted to do was remind the nation of his opposition to our increasing the NHS budget. The motion is about spending, but we can spend only what is in our budget. What did he say about budget and spend during his failed bid for the leadership of his own party? [ Interruption. ] I think that right hon. and hon. Members on the Opposition Benches should listen to what those on their Front Bench are saying. He said:

“It is irresponsible to increase NHS spending in real terms”.

So let me ask him to clarify this to the House: does he stand by his comment that it is irresponsible to increase NHS spending?

Andy Burnham: Yes, I do. I said in my speech that the NHS should be protected in real terms at the front line. That is what the Secretary of State has not done. I cannot believe that he is contradicting the contents of the letter from Andrew Dilnot. He really needs to tread very carefully before he goes any further.

Mr Hunt: Let me say very gently to the right hon. Gentleman that he can hardly come to this House criticising us for an alleged cut in NHS spending if his own plans would have led not to higher but to lower NHS spending. We are increasing spending by £12.5 billion, and he thinks that that is irresponsible.

Grahame M. Morris: Will the Secretary of State at least acknowledge that the previous Labour Government increased resources in the NHS from £30 billion when we took office to over £100 billion when we left office in 2010?

Mr Hunt: I accept that. We wanted to increase spending even further, and the right hon. Member for Leigh said that that was irresponsible.

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Lyn Brown: Will the right hon. Gentleman confirm just how many nurses’ jobs have been cut on this Government’s watch?

Mr Hunt: I will confirm for the hon. Lady that the nurse-to-bed ratio has gone up so that nurses are spending—[ Interruption. ] Perhaps the Opposition will want to hear about issues of care. The average bed is getting an extra two hours of nursing care per week than under Labour.

Let me give the right hon. Member for Leigh another chance to clarify Labour policy on health spending. In Wales, Labour has announced plans to cut the NHS budget by 8% in real terms despite an overall settlement protected by Barnett. Given that the motion condemns an alleged cut in NHS spending, will he, once and for all, condemn the choice that Labour made in Wales? If he does not want to do that, let me tell him what the British Medical Association says is happening in Wales. It talks of a “slash and burn” situation and “panic” on the wards. Would he want that to be repeated in England? If not, he should not sit idly by but have the courage to condemn the choice that Labour has made in Wales.

While we are on the subject of Wales, the right hon. Gentleman will know that NHS patients there are five times less likely to get certain cancer drugs than English NHS patients, but the Labour Welsh Health Minister has said it would be “irresponsible”—the same word that the right hon. Gentleman used—to introduce a cancer drugs fund in Wales. Does the right hon. Member for Leigh support what Labour is doing with regard to cancer drugs in Wales—yes or no?

Andy Burnham indicated assent .

Mr Hunt: He does support it—well, there we are. So now we have it. Labour policy in Wales is to cut the NHS budget, and that is supported by Labour Front Benchers.

Susan Elan Jones (Clwyd South) (Lab): Can the Secretary of State tell us whether that has anything to do with the cuts in capital spend from Westminster central Government? Does he have any comment to make on National Audit Office figures showing that spending on health in Wales is higher than that in England, or does that not fit with his fictitious version of events?

Mr Hunt: I gently remind the hon. Lady that this is about the choice made by the Labour Government in Wales. They had a choice. They could have protected the NHS budget—they had the money under Barnett to do that—but they chose not to do so, and that is supported by the right hon. Gentleman.

Julian Smith: Does it surprise my right hon. Friend that we heard nothing from Labour Members about productivity, innovation or the Derek Wanless report, which demonstrated that Labour’s health spending led to lower productivity rather than better productivity?

Mr Hunt: It absolutely did. The key issue in this debate is the level of spending, and we will explain thoroughly why what the Opposition are saying is quite wrong. However, it is also about how the money is spent.

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Heidi Alexander (Lewisham East) (Lab): Will the Secretary of State give way?

Mr Hunt: I am going to make a little progress, if I may.

The right hon. Member for Leigh rather helpfully spelled out the difference between his position and our position when he admitted in the New Statesman that we are spending more than he wanted to spend on the NHS. He said of the NHS budget:

“They’re not ring-fencing it. They’re increasing it.”

In respect of NHS spending, he said:

“Cameron’s been saying it every week in the Commons: ‘Oh, the shadow health secretary wants to spend less on health than us’…it is true, but that’s my point.”

It was a good point, because we are spending more and he would have spent less. So why on earth call an Alice in Wonderland Opposition day debate condemning levels of spending in the NHS when he has so clearly put it on the record that he wanted that spending to be less?

Mr Graham Stuart (Beverley and Holderness) (Con): Does my right hon. Friend agree that it is disingenuous, should it be allowed by the Deputy Speaker to say that, of the shadow Secretary of State and Labour Members—

Mr Deputy Speaker (Mr Lindsay Hoyle): Order. We are not going to be disingenuous, are we? We are going to be friends together, and I am sure that a good experienced Member like you, Mr Stuart, could word it better.

Mr Stuart: Thank you, Mr Deputy Speaker, for that correction, which I required. Obviously, it is an inadvertent tendency towards disingenuousness on the subject. I would like to apologise for pointing out, on behalf of patients right across the country, that for the Opposition to have a debate on health funding, when they were proposing to cut it—when they are actually cutting it in Wales—and when productivity fell, is the height of hypocrisy.

Mr Deputy Speaker: Order. I do not think we can have “hypocrisy” either, so we will have the Secretary of State instead.

Mr Hunt: The simple truth that Labour Front Benchers cannot understand is that spending is related to budgets, and they wanted the budgets to be lower than they currently are.

Heidi Alexander: The Secretary of State seems to be very keen to ask questions of our Front Benchers. Why will he not answer the question put to him by my hon. Friend the Member for West Ham (Lyn Brown)? How many nurses have lost their jobs on his watch? I do not want to be told about the nurses-to-beds ratio—answer the question.

Mr Hunt: It is because we have protected the NHS budget that the number of clinical staff in the NHS has gone up and not down. [ Interruption. ] Okay, let me explain this, because there is a very important point here. Unlike Labour Front Benchers, I do not want to micro-manage every hospital in the country and tell them exactly how many doctors and how many nurses

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they should have. I want to them to put money on the front line, and the result is that the number of clinical staff—doctors, nurses, midwives and health visitors—has gone up and not down.

Clive Efford rose—

Mr Hunt: I am going to make some progress.

Let me move on to the accusation that the right hon. Member for Leigh made. He says that, using 2009-10 as a base year, NHS spending went down in 2010-11.

Mr Charles Walker (Broxbourne) (Con): Will my right hon. Friend give way?

Mr Hunt: I want to make a little progress and then I will give way.

Mr Walker: I have to chair a Committee shortly.

Mr Hunt: In that case, I will give way.

Mr Deputy Speaker: Order. I am sure that the hon. Member for Broxbourne (Mr Walker) is not going to walk out after his intervention and will stay a little longer.

Mr Walker: The meeting is in thirteen minutes.

My right hon. Friend knows that it is not just about funding but about good management. He cannot be responsible for management across the NHS, but in the East of England ambulance service there are question marks over the quality of its senior management. Will he find time to cast his eye over those senior managers?

Mr Hunt: I assure my hon. Friend that I am aware of the concerns that he raises, which are frequently raised with me by the Minister of State, my hon. Friend the Member for North Norfolk (Norman Lamb), who has a constituency in the east of England. I follow that situation carefully.

Let me now deal with the substance of the motion. I have always talked about spending going up from the first year of the comprehensive spending review—the first year when this Government had full control of the budget and were responsible for setting the spending plans. In 2011-12—[ Interruption. ] The shadow Secretary of State should listen to the facts. He tabled the motion, so he probably should hear the answer, although I know it is not what he wants. In 2011-12, spending went up by £2.5 billion in cash terms—0.1% in real terms—on 2010-11. This year, 2012-13, it will go up again, as it will in every year of the Parliament.

Andy Burnham: Would the Secretary of State care to remind the House of the commitment in the coalition agreement? Could he read that out for us?

Mr Hunt: I have just said that spending will go up in every year of the Parliament. Let me point out to the right hon. Gentleman that these are small real-terms increases, albeit ones that he bitterly opposed. That is why, given the uncertainties around GDP deflators, Andrew Dilnot’s letter says, in the sentence that the right hon. Gentleman did not want to read out, that

“it might also be fair to say real terms expenditure has changed little over this period.”

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There it is, exposed for all to see: a bogus Labour motion trying to paint a picture of cuts to the NHS budget when even the head of the UK Statistics Authority says that the broad picture of NHS spending is that it has been protected in real terms—something that almost certainly would not have happened had Labour been in power.

Andy Burnham: I am struggling to believe what I am hearing. The Secretary of State is saying that Andrew Dilnot agreed with him that there had been real-terms increases in every year of this Parliament—[ Interruption. ] That is what he just said at the Dispatch Box. Let me quote Andrew Dilnot again, for the sake of accuracy. He said that

“we would conclude that expenditure on the NHS in real terms was lower in 2011-12 than it was in 2009-10”.

How can the Secretary of State square what he has just told the House of Commons with what is in Andrew Dilnot’s letter? Is he saying that Andrew Dilnot is wrong?

Mr Hunt: Some politicians walk into the same trap not once but twice. Let me give the right hon. Gentleman the sentence that comes straight after that, which he did not want to quote. It says that

“it might also be fair to say that real-terms expenditure had changed little over this period.”

That is what Andrew Dilnot is saying, which is why the motion is so completely bogus.

Dame Joan Ruddock (Lewisham, Deptford) (Lab): I am no statistician, but my understanding of that English is that things have not changed much. However, the Secretary of State has consistently said that he and the Government have pledged to implement an increase. There is nothing in that letter to suggest that any increase has occurred.

Mr Hunt: The right hon. Lady’s party has been saying that spending has been cut, and it had the foolishness to call an Opposition day debate on the basis of a letter from Andrew Dilnot that states that, broadly speaking, spending has remained unchanged. That is why, at its heart, the motion is bogus.

The sad fact is that this is not the debate that the Opposition planned to have, two years into this Parliament. The right hon. Gentleman dreamed of coming to the House to remonstrate about an NHS that was on its knees and that was not delivering for the public. He wanted to argue about waiting times, but they have gone down, with fewer people waiting a long time for an operation than at any time under Labour. He wanted to argue about treatments, but there are more people getting new hips and knees and many other treatments than under Labour. [ Interruption. ] Opposition Members should listen to this. He wanted to argue about cancer, but 23,000 people are now getting drugs under the cancer drugs fund that Labour refused to set up.

Today, the right hon. Gentleman has tabled a motion criticising the decisions taken by the coalition and my right hon. Friend the Member for South Cambridgeshire (Mr Lansley) on NHS spending in our first two years in office. This is also about how we spend the money, as many of my hon. Friends have said. What are the decisions that the right hon. Gentleman is criticising?

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They are precisely the decisions that mean that the NHS is now performing at record levels, and vastly better than at any time under Labour.

Let us look at those decisions. There was the decision to reduce the number of managers by 7,000 and transfer resources to the front line. There was also the decision to cancel Labour’s disastrous attempt to embrace the technology revolution that cost billions and set the NHS back by years. Then there was the decision to end the wasteful consultancy spend, which has now been cut by 39%. [ Interruption. ] The right hon. Gentleman needs to listen to this. There was the decision to stop the scandal of unsustainable private finance initiative projects that left the NHS with a £73 billion debt and £1.6 billion-worth of repayments every year. [ Interruption. ]

Mr Deputy Speaker (Mr Lindsay Hoyle): Order. Christmas is coming. Let us show a little bit more Christmas spirit towards each other. Members on both sides of the House want to hear the Secretary of State.

Mr Hunt: I could not agree with you more, Mr Deputy Speaker. I am trying to give the House some good news, but it is difficult for the Opposition to take it in.

There was also the decision, championed by both coalition parties, to transfer that money to the front line, so we now have more clinical staff, including 5,000 more doctors; better access to drugs, including £600 million invested in the cancer drugs fund; 500,000 more elective admissions every year than under Labour; over 3 million more out-patient appointments every year than under Labour; nearly 1 million more going through accident and emergency every year than under Labour; and 1.5 million more diagnostic tests every year than under Labour. On top of all that, we have 60,000 fewer people waiting longer than 18 weeks than under Labour; 90% fewer people waiting more than a year than under Labour; clostridium difficile down more than a third compared with under Labour; MRSA halved compared with under Labour; and the number of people facing the indignity of mixed-sex wards down by 98% compared with under Labour.

Of course the NHS faces huge challenges with an ageing population and increasing demand, but we are now facing up to those challenges with ambitious plans to tackle dementia, to reduce mortality rates for the big killer diseases to the lowest in Europe, to embrace the technology revolution—but getting it right this time—and to improve the quality of care which, in parts of the system, has been allowed to become shockingly poor for far too long. All those priorities were ignored by Labour in office and, even worse, they have been rejected by Labour today as a “meaningless list”. Those were Labour’s words. Well, tell that to the 157,000 people who die from cancer every year, or the 800,000 people who have dementia, or the people whose families suffer from the poor care that we read about every week in the newspapers.

None of the improvements to the NHS, and none of the ambitions for our NHS, would be possible without the extraordinary dedication of our doctors, nurses and front-line professionals, to whom I pay tribute today. But none of them would have been possible either if we had not increased the NHS budget and NHS front-line

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spend, contrary to what Labour intended and wanted. Labour’s plans would have meant less spending in real terms on the NHS, and vastly less spending on the NHS front line. No clever fiddling with baselines can obscure the harsh reality that Labour’s policy towards the NHS is a mass of contradictions that fools nobody—certainly not the brilliant doctors, nurses and professionals who have given their lives to saving and improving the lives of others. I urge the House to reject this ridiculous motion.

Several hon. Members rose

Mr Deputy Speaker (Mr Lindsay Hoyle): Order. The time limit on Back-Bench speeches is displayed on the annunciator screen.


2.56 pm

Dame Joan Ruddock (Lewisham, Deptford) (Lab): Today’s debate centres on the Prime Minister’s broken promise to protect the NHS, which was expressed as a commitment to increase spending on the NHS year on year. That is not the only promise that he made. In opposition, he spoke passionately about retaining essential local services and named my local hospital, Lewisham, as one of the 29 hospitals that he would personally defend. Today we can offer him and the Secretary of State for Health that opportunity. The bottom line for NHS spending has to be the provision of safe, quality health care that meets the needs of the local population and is free at the point of need. Nothing is more important to the vast majority of our people.

The four tests that the Government have set for any local reorganisation proposals are: that they should have the support of local GPs; that they should have strong public and patient engagement; that they should be backed by sound clinical evidence; and that they should provide support for patient choice. Not one of those criteria has been met by the current proposals for Lewisham hospital by the trust special administrator.

Mr Graham Stuart: The right hon. Lady is speaking movingly about local services. Does she welcome, as I do, the £12.5 billion increase proposed for the NHS budget during this Parliament? Does she disagree with the right hon. Member for Leigh (Andy Burnham), who believes that such increases are irresponsible?

Dame Joan Ruddock: If the hon. Gentleman will be patient, he will discover that I find it impossible to see the increase. What I see on the ground are cuts, cuts, cuts. That is what I want to speak about today.

As I was saying, not one of those criteria is met by the trust special administrator’s proposals for Lewisham hospital. The TSA was appointed in July by the Secretary of State for Health to sort out the considerable financial problems of the neighbouring South London Healthcare NHS Trust. His remit required him to find tens of millions of pounds of savings from the services provided by the trust’s hospitals in Woolwich, Farnborough and Sidcup. That could not be done, so the TSA’s response was to grab a successful, solvent and highly regarded hospital, Lewisham, and propose to destroy it to raise money from the sale of two thirds of the site currently occupied by the hospital, a fact that was not even mentioned in the consultation document.

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Andy Sawford (Corby) (Lab/Co-op): My right hon. Friend will be aware that my constituents have similar concerns about the future of their local hospital in Kettering, despite assurances that changes are being driven by the best clinical advice and guidance and by clinical outcomes. Contrary to the unrecognisable picture described by those on the Government Benches, we know that the cuts in Kettering hospital’s services, which will affect my constituents in Corby and east Northamptonshire, are a result of a £48 million deficit that is a direct result of the Government’s policies. Does my right hon. Friend share my concern that this is about those cuts in funding rather than the clinical outcomes?

Dame Joan Ruddock: I thank my hon. Friend for his intervention. If all hon. Members are honest in providing a record of what is happening on the ground, we will see that the reality is, indeed, cuts and reductions in services.

It is a case of not only how much money we spend on the NHS, but how wisely we can spend it, and there may be agreement throughout the House on that. [ Interruption. ] I say to the hon. Member for Beverley and Holderness (Mr Stuart) that just four years ago, Lewisham hospital gained a new wing through a successful and affordable private finance initiative contract. Just two years ago, a state of the art new birthing centre was opened, and only in April of this year the £12 million refurbishment of the A and E department was completed.

Now, however, the trust special administrator proposes to close both the full A and E service and the full maternity service at Lewisham hospital. The consequence of closing the A and E department and replacing it with an urgent care centre means the closure of the intensive care unit, the coronary care unit and the acute medical and elderly medical services. Every year, more than 13,000 people benefit from those acute services, 4,500 babies are born in the maternity unit, and more than 120,000 people use the A and E department.

The proposals are, to be frank, catastrophic—they will remove vital services from a growing population of more than 270,000 people. This is an accountant’s solution to a problem that does not even exist in Lewisham itself. Not a single constituent, patient, GP or hospital specialist has come to me in support of the plans.

My colleagues, Lewisham hospital trust and I are not opposed to change aimed at greater efficiencies and higher standards. Indeed, that was the Labour Government’s policy and philosophy for the NHS all along. We know that closures of small hospitals have led to safer services. We know that paramedic services and blue-light ambulances taking people to highly specialised centres save lives every day. We also know that the NHS could be more efficient, but there is no evidence that the needs of Lewisham people for A and E or maternity services can be safely met elsewhere in south-east London. All other existing provision is full to capacity, and travel from most of Lewisham to Woolwich is highly problematic.

The TSA report is full of assertions and aspirations that are completely divorced from the realities of people’s lives in a borough that contains some of the most deprived wards in the UK. If the proposals were to go ahead, the 750,000 residents in the boroughs of Lewisham, Greenwich and Bromley would be dependent on a single A and E department. As the report says, hospitals are part of a bigger NHS family, which is why the Secretary of State must look at London as a whole. It

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cannot be just or sensible to try to find enormous financial savings to rescue one health trust by destroying another.

The public have had just 30 days to respond to the extraordinary proposals in what is a deeply flawed consultation process, but such is the anger that more than 32,000 people, including more than 100 local GPs, had added their names to a petition started by my hon. Friend the Member for Lewisham East (Heidi Alexander) by the time we presented it to No. 10 last Friday.

Last week the trust board of Lewisham hospital issued its response. It supports in principle the merger of Lewisham with Queen Elizabeth hospital in Woolwich, and I must say that that is worth considering, but the trust says:

“We are concerned that the financial modelling completed by the TSA team at pace will include errors that will work against financial viability of the proposed Lewisham Healthcare NHS Trust and Queen Elizabeth hospital reorganisation.”

That would simply repeat the history of the hospitals in the South London Healthcare Trust that have had continuing financial problems.

The trust board goes on to say:

“The TSA process has made it impossible to have the engagement and involvement that proposals such as these would normally warrant, and our clinicians do not feel they have been listened to in this process.”

The rest of its submission to the TSA is entirely damning. It says:

“We do not believe there is a convincing case for the major change of services proposed in Lewisham. The TSA has overlooked the significant role that LHT provides in the broader provision of services to local people. The TSA recommendations will result in worse, rather than better, care for the people of Lewisham. We believe a health and equalities impact assessment would show this but has not yet been completed—a significant weakness of the TSA Report.”

When the Secretary of State comes to view the TSA’s report, whatever form it takes, I urge him also to review all of the evidence that has been presented by local people, local experts, local consultants, GPs and the hospital trust itself. As the local Save Lewisham Hospital campaign says, this is not a difficult decision for the Government—it is potentially a deadly one. I urge him to give the most careful consideration to what is being said. The criticisms are damning and we have absolutely no faith in the proposals that the TSA will put before him.

3.7 pm

Mr Stephen Dorrell (Charnwood) (Con): You challenged us earlier, Mr Deputy Speaker, to introduce a little Christmas good will to the debate, and I want to try to do that in two ways. First, I want to respond to the right hon. Member for Lewisham, Deptford (Dame Joan Ruddock), who spoke from the perspective of the local constituency and community interest in Lewisham. The challenges that she described repeat themselves many times over in the health care system, and it is those challenges that I want to address.

Secondly, I want to surprise the shadow Health Secretary, the right hon. Member for Leigh (Andy Burnham), by welcoming the fact that his motion, although I do not endorse it, refocuses the health debate back on the core challenge facing the health service, and the health and care system more broadly, as it thinks about how we

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meet demand—in truth, there is bipartisan agreement on this—in the more challenging resource environment in which we now live.

Although we were not able to detect it in the right hon. Gentleman’s speech, the fact is that he, as Secretary of State, introduced the changed resource outlook within which the health and care system now operates. It was in May 2009—not on election day in May 2010—that Sir David Nicholson issued his annual report on the challenges facing the national health service. He made it clear that the system has to meet demand against the background of a resource outlook that is not only unrecognisably different from that during the generous funding of the Labour years between 1997 and 2010, but that has fundamentally changed from the one that the NHS has experienced throughout its whole history since 1948.

Andy Burnham: I agree with the right hon. Gentleman that I had to give the NHS that reality check and set the Nicholson challenge. With that in mind, does he agree that the Nicholson challenge should have been the only show in town after 2010, and that it was catastrophic to combine it with the biggest ever reorganisation that the NHS has ever seen?

Mr Dorrell: The right hon. Gentleman knows that I agree that the prime focus of health policy since 2010 should have been on how we can change the way that care is delivered in the health care system and the social care system to ensure that we can meet demand against the very different resource outlook that I have described. However, I say to the right hon. Gentleman, as I have done many times in this Chamber, that he shares some of the responsibility for the two-year trip down memory lane that we have had. It has been comfortable for the Labour party to say that the Tory party does not believe in the health service. We have been reminded numerous times that Tory MPs—all of whom are now dead and most of whom died before most of the current Members of the House of Commons were born—voted against the establishment of the national health service in 1946. We have had reminders from Government Members that the Labour party voted against the establishment of NHS trusts and then went ahead with the policy in office. The Labour party says that it is against choice and competition, but it was that party that established the choice and competition panel to ensure that those influences were brought to bear in health care policy.

We have had a two-year trip down memory lane, in which we have engaged in party political arguments that have avoided the issue that the right hon. Gentleman articulated as Secretary of State: how can we meet rising demand for health and care services against the background of a budget that, as the Select Committee has said repeatedly, is flatlining in real terms? That is why I was so keen earlier to read out the sentence from the Dilnot letter that states that it is

“fair to say that real terms expenditure had changed little over this period.”

The way that I prefer to put it is that if the decimal points are knocked out, real-terms expenditure is running at zero. The question is how to act against the background of a very small growth in resources, which is what the Government are committed to.

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What the right hon. Gentleman did not cover in his speech is that the revenue expenditure of the NHS, which is what actually treats patients on a day-by-day basis, has grown modestly in real terms since his last year as Secretary of State. In my view, it will continue to grow modestly in real terms. He is frowning, but it is there in the arithmetic that there has been modest real-terms growth in the revenue expenditure, which is another definition of front-line services. That is the expenditure that funds the delivery of services to patients on a day-by-day basis and that is where the pressure is felt.

Lucy Powell: In addition to the point that the right hon. Gentleman is making, has he considered the chronic pressure that is being put on the NHS, which will get much worse from next April with the cuts to adult social care and the desperate cuts to local government? The conversation that we are having has to take into account what the money has to be spent on. The service will decline dramatically from next April.

Mr Dorrell: I have made the point more than once that we should look across the traditional divide between the national health service and the social care system towards a health and care system. The only way of responding to the efficiency challenge that the right hon. Member for Leigh was the first Secretary of State to set out—what the Select Committee has described as the Nicholson challenge—is to rethink the way in which services are delivered across the health and social care divide. The National Audit Office, another independent body, has stated that 30% of non-emergency hospital admissions are avoidable—not unnecessary, but avoidable. We need decent community-based services that meet the demand early in the development of the condition to avoid the unnecessary development of acute cases that have to be treated though hospital admission.

Andy Sawford: The right hon. Gentleman has been a vocal advocate for a long-term solution to the issues relating to the integration of health and social care. I have enjoyed engaging with him on those issues in the past. Does he agree that it is incredibly disappointing that we are not making the progress that we should be making in finding consensus on the future of social care funding and, in the short term, on diverting more funding, particularly from NHS underspends, to prevention?

Mr Dorrell: I agree completely with the hon. Gentleman’s characterisation of the challenge. I was looking forward to him congratulating the Government on taking a step in the right direction, although it is not a total solution, by investing in prevention some of the resources in the health care. [ Interruption. ] The hon. Gentleman indicates that it is only a little and that it should be more.

We need to look across the statutory divide that reflects history, but not the demands of today’s generation of patients. The key thing that we must recognise in the debate about health and care is that we have inherited a system, which all of us have supported through most of its history, that is built on the assumption that the typical patient will be restored to good health. In Bevan’s day, that was true of the typical patient in the health and care system, but it is not true of the typical patient in today’s system. The majority of the resources in today’s health and care system go towards delivering

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care to people who will not be restored to full health. That, not surprisingly, requires a different set of institutions, shaped in a different way from the institutions that we have inherited from history.

The challenge that faces all of us in this House who care about the health and care system is not to protect the different bits of the system as though they were listed buildings, but to change the system so that it uses today’s technologies to meet the needs of today’s patients. That is the core challenge that faces my right hon. Friend the Secretary of State and his colleagues and, if I may say so, the right hon. Member for Leigh and his shadow ministerial colleagues.

Mr Graham Stuart: Will my right hon. Friend give way?

Mr Dorrell: If my hon. Friend will forgive me, I will not.

For the second half of this Parliament, we could have a reprise of the first half and we could trade party political slogans about a system that increasingly thinks that the political debate has nothing to do with it, or we could engage with the people who understand what real life feels like on the front line of the system, which has been described by one or two Opposition Members, and we could show that we in this House support the need for change in order to use taxpayers’ resources to meet taxpayers’ health and care needs. That is the real challenge that faces the House this evening.

3.18 pm

Mr Kevin Barron (Rother Valley) (Lab): I am sorry that the Secretary of State is leaving because, before going on to discuss what is happening in my local health community and local hospital, I want to pick up on a couple of the things that have been said. First, I am pleased that this very dry motion has been tabled because I hope that it will concentrate our minds on what is happening in the national health service and, in particular, to spending.

The Secretary of State said that spending is related to budgets. He did not respond to the point posed by my right hon. Friend the Member for Leigh (Andy Burnham) that in 2010-11, there was a £1.9 billion underspend in the national health service budget. No use was made of the budget exchange scheme, so none of that money was moved into the following financial year. We can assume that £1.9 billion went back to the Treasury.

In the following year, 2011-12, the underspend was £1.4 billion, and £316 million was carried over into 2012-13. An underspend in the region of £3 billion from the first two years of this Government—including the year they won the general election—has gone back to the Treasury. Those are the facts; I do not know if any Front Bench Member wishes to dispute them.

The Minister of State, Department of Health (Norman Lamb): Does the right hon. Gentleman also acknowledge that the average underspend in the last four years of the Labour Government was £1.9 billion?

Mr Barron: I recognise that there has been underspend, but I take this debate, and the debate we had running up to the general election, a bit more seriously. The chairman of the UK Statistics Authority said that there had been

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an underspend, and what we have just heard is not true. As my right hon. Friend the Member for Leigh (Andy Burnham) said, the Conservative party manifesto stated:

“We will increase health spending in real terms every year.”

Mr Graham Stuart: Will the right hon. Gentleman give way?

Mr Barron: I will give way in a few minutes. When the Conservative party was in opposition, the current Prime Minister said in 2009:

“With the Conservatives there will no more of the tiresome, meddlesome, top-down re-structures that have dominated the last decade of the NHS.”

I want to keep reminding hon. Members of that because, as my right hon. Friend the Member for Leigh pointed out, we may be able to take £20 billion out of a budget over four years—that is a big ask and has never been done anywhere in the public or private sector—but to do it while we are also having mass reorganisation is creating chaos in the health service. I will refer to what is happening in my local health service in few minutes.

In 2007 the right hon. Member for South Cambridgeshire (Mr Lansley) was shadow Secretary of State for Health, although he has now moved to Leader of the House. He said that the NHS needed

“no more top-down reorganisations.”

Indeed, in terms of expenditure the coalition agreement stated:

“We will guarantee that health spending increases in real terms, in each year of the Parliament, while recognising the impact this decision will have on other departments.”

It also stated:

“We will stop the top-down re-organisations of the NHS”

so we can take that with a pinch of salt as well.

Mr Graham Stuart rose

Mr Barron: I will give way to the hon. Gentleman before I move on to what is happening to the NHS in the real world.

Mr Stuart: Like my right hon. Friend the Member for Charnwood (Mr Dorrell), the right hon. Member for Rother Valley (Mr Barron) is a former distinguished Chairman of the Health Committee. My right hon. Friend rightly said that spending on the NHS is broadly flat, and that the most important question we should be debating, rather than scoring points over 0.1% of spend, is how to use the money most effectively. Does the right hon. Gentleman agree with that, and that we must look at the allocation of spend around the country? I represent a rural area and it does not seem as if funds are fairly allocated now.

Mr Barron: The issue of allocation has been looked at by many Select Committees, including by the Health Committee when I chaired it in the last Parliament. We did not find the level of unfairness that people, particularly those from rural areas, used to say there was. We looked for it but we did not find it.

Let us look at what is happening in the real world. My local Rotherham hospital foundation trust is not a bad hospital trust in any way and scores quite well in many areas. It received foundation trust status a number of years ago, and when this Government took office, it

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is fair to say that the efficiency factor was there already. On 16 March 2011 the trust announced that more than 60 jobs were to be axed at Rotherham general hospital, and confirmed a potential reduction of 62 posts in medical and surgical areas. Earlier this year on 6 March 2012, the local BBC announced that more than 70 NHS staff were facing the threat of redundancy, and the trust is seeking to save about £4 million. On 26 October 2012, an internal report given to the local media stated that the trust now intends to cut 750 jobs—about 20% of its work force—by 2015.

The NHS trust said that it needed a smaller hospital with substantially fewer beds and a smaller work force to save £50 million over the next four years. The internal report—aptly named, “Creating Certainty in an Uncertain World”—said that it was necessary to save £50 million from the £220 million budget before 2015 to meet Government targets. That was confirmed by the trust in a press release.

On 5 November 2012, the chief executive of the trust said that it would show staff the plans and invite them to come back with alternative views on how things might be done differently. The trust stated:

“We’ve made it very clear that there may have to be redundancies, but to be honest with you until we have gone through the process, I don’t know how many we will be able to lose through natural turnover and how many will have to be made redundant.”

What type of planning is there in any of this when we have such a situation in a district general hospital on which about 80% of my constituents rely if they have to go into secondary care?

On 20 November 2012, the chief executive announced his retirement. On 3 December 2012, the hospital announced that staff will be informed about the decision to postpone the formal consultation launch into work force restructuring. It went on:

“We realise this an anxious time for all members of staff, but it is imperative that we do what is right for the Trust, our staff and our patients. This means that we need to take more time to ensure our workforce proposal is exactly what the Trust requires and we anticipate the launch to take place later in the month.”

On 7 December 2012—last Friday—a headline in the local newspaper stated that the trust had recently engaged the services of a director of transformation on a time-limited basis. The acting chief executive said:

“It is important that the trust acts quickly to take the action required to safeguard the future clinical and financial sustainability of the Trust. This appointment, which was made after a competitive process, is required to provide additional expertise and impetus to the changes we need to make, whilst allowing others to remain focused on delivering the healthcare services that the people of Rotherham need and deserve.”

I do not stand here and support the way the NHS has been structured now or in the past, and I have been critical about many areas of that. I agree with the chief executive of the NHS, David Nicholson, when he said at the NHS confederation conference this year:

“We need to change the model of care to one which supports patients and focuses more on preventing ill health from happening in the first place...and move away from the default position of getting someone into a hospital bed.”

At the same conference the then Health Secretary said that closure decisions were not an issue for national politicians, and my right hon. Friend the Member for

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Leigh said that the current Health Secretary said very much the same thing—“It’s nothing to do with me, guv.”

Let me say to the Minister, and other hon. Members who have made relevant interventions, that if changes and reconfigurations inside the national health service are getting better care to more patients, that is fine. However, the chaos in my local health service is about cutting back and saving money. I have played an active role in health care in my constituency over many years and, as far as I know, there has been no debate with local Members of Parliament, patients, patient groups, local doctors or people engaged in health provision in Rotherham. There have been no discussions whatever about reconfiguring the district general hospital to improve the position of patients and of the people of Rotherham and the surrounding area. Instead there is a drive to save money, which is creating chaos in my local health service.

Norman Lamb: Does that not demonstrate a complete failure at local level to address the real problems that we are trying to grapple with? There is therefore a case for a changed system whereby a health and wellbeing board brings all the parts of the system together to debate such issues.

Mr Barron: The events of the past two months suggest to me that the people in whom the Minister has faith to reorganise health care in Rotherham do not know what they are doing. They have brought in new systems and produced a report inside the hospital, which I understand was given to the trade unions. It ended up on the front page of a local newspaper and was countered by a press release by the hospital itself. Where is the debate about improving health care for my constituents and others? It is absent.

I say to the Minister that it was wholly wrong for the previous and current Secretaries of State—he is not the Secretary of State himself, but we never know, he may be one day—to say “These are not matters for Ministers”. I have not been consulted about them. The three local MPs had an appointment with the chief executive of the trust about two weeks ago, but it was cancelled because he had announced his retirement the week before. That is not acceptable.

The hard reality on the ground is that no matter what we would like to happen in health care, trusts are charging into cutting budgets. They are cutting jobs, because that is where the major expenditure is in health care, and that is creating the chaos that I have described. It is not acceptable. My constituents pay their taxes to pay for health care—it does not come out of the budget down here in Westminster—and they deserve better than what they are getting at the moment.

3.30 pm

John Pugh (Southport) (LD): While you were not in the Chair, Mr Speaker, you missed a lively and interesting but predictably arid debate. We have reached a kind of stalemate. Those who understand the dark art of political messaging tell me that it is important to say the same things again and again, and psychologists tell me that those who do that are more likely to be believed. Prior to the election, the Tories were unique in having as an important part of their messaging the wish to ring-fence and preserve NHS spending.

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That message was then embodied in the coalition agreement and has influenced subsequent spending decisions. We all recognise that there are good reasons for that—the NHS is a demand-led service. It is therefore perfectly sensible, in the Westminster bubble, for the Opposition to make an issue of it. Members have come to the debate with predictable information from the Whips-SpAd axis about the private finance initiative, the misdemeanours of Wales, evidence of unexpected service rationing, reconfiguration trouble, positive and negative variations in waiting lists and ambiguous data on productivity. We have all been given that stuff, and we can use it as we wish.

Meanwhile, the public have clocked that we have a real problem. The demands and expectations on the NHS will continue to rise, resources are tight and there will potentially be a huge problem. They know that politicians cannot be seen to reduce the NHS offer—they simply would not tolerate that. They do not know quite how all the sums will ultimately stack up, and nor do we. That is the big question.

Andy Sawford: Will the hon. Gentleman accept, though, in the interests of being transparent with the public, last week’s letter from Andrew Dilnot, the chair of the UK Statistics Authority?

Mr Graham Stuart: Move on.

Andy Sawford: The letter stated unequivocally that

“we would conclude that expenditure on the NHS in real terms was lower in 2011-12 than it was in 2009-10.”

Until both Government parties acknowledge that truth, which independent experts have told us about, they will not have any credibility in health debates.

John Pugh: I think I will take the advice of my hon. Friend the Member for Beverley and Holderness (Mr Stuart) and move on.

I think we all agree that the only acceptable answer to the problem is to spend public money wisely. Currently, the NHS is holding up—sort of—by making economies and savings, largely off the back of a wage freeze, which is not sustainable. However, I am starting to be alarmed by the disagreement about what else we can do and what strategies we should follow. I will run briefly through the suggested options.

It has been suggested that we should keep people out of hospital, but we already have fewer hospital beds than almost anywhere else in Europe, and according to the NHS Confederation there is no clear evidence that treating people outside hospital would necessarily be cheaper.

Some people recommend personalisation and personal budgets, but it can be argued that that would not lead to better use of scarce resources, despite the fact that it would be more popular than some current service configurations. Telehealth has also been suggested, and I am a great enthusiast for it—it is my personal favourite suggestion, and I am chair of the all-party telehealth group. However, although there are cost-effective pilots, the Nuffield Trust has expressed some criticism of telehealth, saying that it may not save us anything like the money that we believe it will. The industry itself is concerned that if the roll-out is not efficient and effective enough, telehealth simply will not take off.

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Mr Dorrell: I am listening carefully to my hon. Friend, and I have some sympathy with him, but will he acknowledge that the arguments for those options are partly about health economics but partly related to the need to deliver better quality to those who rely on community-based services? We do not want acute cases if they are avoidable.

John Pugh: I agree; none the less, we both agree that there is still a huge economic problem.

Even reducing the number of managers has mixed impacts, because asking doctors to manage services or buy in management service from elsewhere has cost implications. It uses up medical time, which needs to be replaced. Then there is the blighted history of IT and the uncertain role of technology and innovation, which can increase demand but also reduce cost. Even if we see public health as the answer, it is still not a complete answer by itself, because if we do not solve the huge problem of dementia, there is no saying that prolonging life and keeping people fit will necessarily reduce overall costs in the long run. If we look at things such as rewarding doctors through the quality and outcomes framework, and so on, we find some pretty expensive deployment of public money, albeit not always to massive effect. The point I am trying to make is that there is a whole medicine chest of remedies available, but no complete agreement on precisely how or where best to use them. None of them seems to be a cure-all, and many have undesired side effects.

As we choose to use those remedies, they need to be employed with skill, judgment and the benefits of experience, because we are dealing with an almost insurmountable problem. We have to approach the problem—almost like good medicine—using the right remedy, at the right time, in the right way and with skill, judgment and experience. However, that will not result simply from using market forces or creating some sort of ersatz market—that is just another tool we might choose to use. What we want—I am sure the Minister agrees—is integrated services, which would avoid expensive duplication, cost-shunting and piecemeal provision. It would be really nice if we could exploit better economies of scale in procurement, for example, or make better use of the NHS estate. It would be nice if we could discover good practice and roll it out across the piece quickly. It would be really nice if the NHS was a well oiled and efficient machine—a truly integrated system with proper clinical networks that were properly protected. It would be nice if we got what the Minister describes as integration, which is a kind of holy grail at the moment.

However, I have a problem—I am sure the Minister has a response to it—in that we have just abolished what I think would be the best agency for integration. The strategic health authority, unloved as it was—a bit obese, misunderstood, and so on—was a vehicle that could perform that role, applying the right remedies in the right place. I must own up: we decided in the Lib Dem manifesto that we wanted to get rid of the SHA. However, perhaps over the fullness of time the NHS Commissioning Board will create something like that—quietly, privately—because to some extent, I think we all agree, it is needed. In the meanwhile, there are key things we need to get on with. We can certainly improve procurement without any difficulty. We can try to release ourselves from the pointless grip of the EU working

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time directive, which adds appreciably to salary costs. We can also work hard to move data around the system better. There is an enormous amount to do and it is not obvious who is going to do it.

3.37 pm

Ann Clwyd (Cynon Valley) (Lab): I am not going to make a speech as such; I am just going to read some quotations from the hundreds and hundreds of personal testimonies that I have received in the last few days.

“I am a former director of nursing at a university teaching hospital…Since my retirement…there have been four occasions when it was necessary for me to visit family and friends in hospital. Each visit resulted in a serious formal complaint about the standard of nursing care and medical diagnosis, experiences that have caused me to be ashamed of the profession I was once very proud of.

In the first incident a friend, dying, was left sat in a chair at visiting time with no pyjamas and his genitals exposed. On making inquires we were told that no clean pyjamas were available.

My mother was in hospital suffering from a bladder infection some weeks after bowel surgery for cancer…When we arrived she wanted to use the toilet, having asked for help several times. We found her being completely ignored so I took her to the toilet myself. On our way there she could not hold the flow of urine, most of which poured onto the floor of the ward. Naturally she felt ashamed, embarrassed and humiliated. At that time, and in full view, not one nurse was attending patients at their bedside and we counted eight nurses and a doctor doing nothing at the nurses station. My family insisted that mother be transferred to another hospital where within two hours she was diagnosed with malnutrition and dehydration—mother had been in the previous hospital for three weeks! Unfortunately the new hospital, a few days later, ran out of colostomy bags and just left mother in a faeces-covered bed.”

Another statement says:

“I was trained as a nurse myself when I was young, and subsequently retrained as a Community Worker and then a Social Worker. I worked in community care Social Work for 20 years. I also witnessed many incidents of inhumane treatments in hospital settings whilst working in Community Care…My… father was admitted to hospital due to some long standing serious bowel problems...Not long after being admitted, my father contracted C. difficile, from which he did not recover. He was frequently left lying in his own faeces. His basic care needs were neglected on every level, and he was made to feel guilty every time he soiled the bed. He developed such severe Thrush in his mouth, he was unable to eat or wear his false teeth. Despite numerous requests for treatment, it was never treated. I also tried numerous times to have him transferred to the small local hospital for palliative care as it was obvious to me that he was dying, but the staff insisted that he was NOT terminally ill…In the end, I DID stand in the corridor in desperation and virtually scream. I shouted at the nurse in charge, ‘The treatment of my father is f***ing inhumane’ and demanded that he was moved for palliative care…This happened after I found my dying father lying half out of a chair with freezing cold bare feet and one light blanket in late afternoon. According to other patients he had been sitting there since early morning. (It was easier for nurses to clean him up if he soiled himself in the chair, although they used the excuse of it being good for him.) He died in the small local hospital 3 days later. The staff there said his bed sores were so extensive and severe, there was nothing they could do for him. They kept him comfortable, and thankfully allowed him to finally die with some dignity and tender, loving care. However, by this time, my beloved gentle father had endured 3 months of indignity, abuse and misery.”

Another testimonial said:

“Your story was so similar to the loss of my dad exactly 2 years ago in our local hospital…he had worked from the age of 14 until his 65th birthday, he was in the RAF in the war and he was

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treated in the most dreadful way by most of the nursing staff, doctors and administrators at the hospital. We became frightened of pushing them to be kinder whilst he was in their care, in case, if possible, things became even worse. Surely something must be done about this situation. I could hardly believe my ears the other day when a representative of the nursing profession was saying they are pushing for an emphasis on compassion and consideration in nursing—when did this disappear? I would have thought it was part of the human condition to want to care for and help a person or a creature who is suffering.”

Another letter says:

“My friend and I have both experienced appalling neglect and abuse to close relatives at the hands of NHS nurses (at completely different hospitals—one in the Midlands and one in Surrey) who received no dignity or care right up to the moment they died…We find it equally sickening when we hear people…describe nurses as ‘Angels’! We also have to endure the continual mythology surrounding Nursing as a profession, e.g. ‘it’s low paid, low morale, poor staffing levels etc.’—when in reality nursing pay scales have increased dramatically over the last decade and it is now a well paid profession compared to many other jobs like hospital porters., and crucially, even if there is genuinely low morale it never excuses such blatant cruelty.”

Another letter read:

“When I sat at my husband’s bedside I did wonder…why some of the so called nurses bothered to put on their uniforms. The arrogance and indifference of some left me bewildered. The Ward Sister of the ward my husband had the misfortune to be sent to after the excellent intensive ward did not bother to speak to me for the whole 17 days he was on her ward and I am told that she was so busy running the ward she did not have time to talk to relatives…As a Doctor said in an article in the Daily Telegraph a few weeks ago since they made nursing a degree course the wrong kind of people are entering the profession and they think they are above the menial tasks that the old fashioned nurses undertook from day one. We do not need a load of snooty nosed pen pushers, we need compassionate nurses who are entering the profession because they care for people not for the salary.”

Another letter read:

“My father, who was a GP…had a severe stroke. He went to hospital and they would leave the food in front of him to ‘look at’. He was paralysed and could not use his arms or legs. If we were not there, he would not be fed or given any fluid. Then they didn’t pull the side gates up on the bed and he fell out and broke his femur.”

Another letter read:

“I feel that indifference by nursing staff to patients’ suffering and needs is all too common, and those nurses who show kindness and take time with their patients stand out as the exception.”

Another letter read:

“I do know how understaffed the nurses were in my mother's ward but I found a dismissive attitude from all levels of medical staff including nurses, consultants, surgeons and ward orderlies. Nobody cared about our mother or took a moment to get to know her. I barely managed to keep my temper, fearful that an angry outburst from me would rebound on my poor mother. Cruelty, indifference and a cavalier attitude to my mother's care marked her final weeks of a long life in which she devoted herself to the care of others.”

I ask the Secretary of State: what is going wrong?

3.46 pm

Stephen McPartland (Stevenage) (Con): Thank you, Mr. Speaker, for giving me the opportunity to contribute to this important debate. Let me first pay tribute to the impassioned speech made by the right hon. Member for Cynon Valley (Ann Clwyd). The tales that she told almost left me in tears, and it is hard to imagine how difficult it must have been for her to read so many stories of that kind, given the unfortunate position in

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which her own family have been. I know that there are a number of nurses in the Chamber today, and in my constituency, who would be horrified to hear what happened to those individuals, and to the right hon. Lady’s family. No one would want anyone to be treated in such a manner. I think that her speech illustrated the difficulties involved in arguing about whether 0.1% is an increase or a decrease, and underlined the fact that today’s debate should focus on whether or not we provide good-quality patient care.

Sarah Newton (Truro and Falmouth) (Con): Will my hon. Friend join me in praising NHS members of staff, including nurses, who are brave enough to come forward and express concern to the senior management of hospitals and in other settings when they see that their colleagues are not putting patient care first and are providing poor-quality care, so that appropriate action can be taken and atrocities such as those about which we have just heard can be prevented?

Stephen McPartland: I entirely agree. My hon. Friend has made an important point about the courage of staff whom many would describe as whistleblowers, and who are getting into a great deal of trouble not only with their management for casting light on what is going on in a particular hospital, but with their colleagues for telling tales.

I am proud of the NHS, I am very proud of the staff who work in it, and I am proud to have the Lister hospital in my constituency. We have heard much impassioned talk about the NHS throughout the Chamber today. I think it is fantastic that Members on both sides of the House, and all Members individually, do all that they can to improve the NHS and the service with which their constituents are provided on a day-to-day basis. I know how proud I am of the doctors, nurses and clinical staff who save lives every day in my constituency, and I know that the headlines only appear when things go wrong.

In my constituency there is an organisation called POhWER that provides an advocacy service to some of the most vulnerable individuals who are having difficulties with the NHS. It now has contracts for London, the south-east, the midlands and the east of England. It was created many years ago by a group of service users who were severely disabled and had difficulties daily in interacting with their NHS and other services. They created this charity and are its trustees. It has helped hundreds of thousands of people. It launched a telephone service in the middle of last year, and it has already received 30,000 telephone calls. I had the great pleasure yesterday of taking those involved to see the Minister with responsibility for charities, my hon. Friend the Member for Ruislip, Northwood and Pinner (Mr Hurd), to demonstrate some of the work they are doing.

Every Member, irrespective of party, wants their NHS to be the best it can be and to provide the best possible care to their constituents. We can all make political points, and my hon. Friend the Member for Southport (John Pugh) referred to the fact that the Whips on both sides put out lots of statements for us to use to attack each other. We could argue that spending in the health service in Wales is going down by 8% under the Labour Administration there, but I do not want to put that case.

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Instead, I want to say how much I respect the right hon. Member for Leigh (Andy Burnham). It was refreshing to hear him say he felt he did all he could in terms of NHS spending given the constraints of the budget he had. I do not want to cast political aspersions, because I have a great deal of respect for the right hon. Gentleman. I believe he wanted to improve the NHS every bit as much as our Secretary of State and Ministers want to do so. I dearly wish the NHS was not a political football and we did not bandy about figures and information.

A great deal has been said about the first and second part of a sentence in a letter from Mr Dilnot. I have read the letter. I imagine most people would not really care about whether 0.1% less or more money was going into the NHS. They are interested in the fact that £12.5 billion extra is going in over this Parliament. The Health Committee Chairman, my right hon. Friend the Member for Charnwood (Mr Dorrell), made a powerful and eloquent speech—it was far more eloquent than mine. He explained that revenue expenditure has been growing modestly over the past couple of years, and that is the expenditure that the day-to-day care delivered to patients in the NHS comes from.

Nigel Adams (Selby and Ainsty) (Con): Does my hon. Friend accept that there is discrimination against certain parts of the country, such as rural constituencies, including mine in North Yorkshire? As my constituency is rural and has a lot of elderly residents, we do not seem to get our fair share from the funding formula.

Stephen McPartland: I do not represent a rural constituency, but I think everybody in every part of the country should have access to the best possible heath service and there should not be any postcode rationing issues. My hon. Friend’s constituents should have access to the best NHS care; indeed, I hope it is almost as good as the care my constituents get.

NHS spending should be focused on improving the quality of care and the experience of patients and their families. We all know that things go wrong, and one of the problems is that when things go wrong, doors get closed and people feel very vulnerable and lonely. People put their mother, father, brother, sister, son or daughter in the hands of someone whom they consider a professional, and they place their trust in them. I hope all of us feel able to put our trust in those professionals.

Gloria De Piero (Ashfield) (Lab): In Ashfield, there are proposals to close down wards at the community hospital. If the closure goes ahead, the situation will be particularly difficult for some patients who suffer from severe dementia, as their relatives will have to travel 17 miles to see them. Does the hon. Gentleman agree that that is unacceptable?